1 reviews | Active since Nov 2012
Numerous issues with incedent date and supporting documentation
I am yet again having issues with my Kaelo Gap Cover. My son needs to go for a tonsillectomy on 29 April 2025. I visited the ENT on 28/03/2025 and the procedure is booked for 29/04/2025. I did get authorisation from my medical aid on 31/03/2025, but was notified that there is a co-payment that needs to be made to the hospital. On 31/03/2025 is submitted the claim for the co-payment via the Kaelo online portal and also phoned to confirm that the claim was received and it was confirmed that it had received. I submitted the letter from the ENT for the procedure as well as the authorisation letter from the medical confirming the co-payment amount. On 2 April I received an email from Kaelo requesting further documentation from me and indicating that the incident date was 29/03/2025 which was incorrect. I then phoned them on 03/04/2025 explaining them that the incident date is incorrect. I also emailed them the authorisation letter from the medical aid as well as the letter from the ENT confrirming the procedure on 29/04/2025. Ad this is a future dated procedure, there will, logically, not be a hospital account nor a medical aid statement as the procedure had not taken place yet. I also stated in the mail that the incident date is incorrect. On 04/03/2025 I received a mail confirming that the supporting documentation has been received. On 07/04/2025 I received yet another mail from Kaelo requesting a hospital statement for 29/03/2025 as well as medical aid statement for 29/03/2025. Again, the incident date was noted as 29/03/2025. THE DATE FOR THE PROCEDURE IS 29/04/2025 AND NOT 29/03/2025. There will not be a hospital statement nor a medical aid statement as the procedure requires a co-payment as well the simple fact that the procedure has not taken place yet. I am at my wits end with having to explain this and I am hoping someone higher up will contact me in order to get this resolved. At this stage I am wondering if this is a stalling tactic to delay the pay-out of the claim...
Best regards,
Best regards,
Best regards,
Best regards,
Best regards,
Best regards,
